It was March 2007 and the pretty, raven-haired 20-year-old was there to visit her uncle, Rodolfo Ramos. But she barely recognized the man who lay in the bed before her. His eyes, once a warm, mischievous brown, were half-closed, dull, and unfocused. He was slack-jawed — lips purple, swollen, and cracked. His normally latte-color skin was pale and tinged with death.

Shaking, Yeisleny stepped closer and gently stroked his skinny arm. She peered at his face, focusing on his nose and cheeks, where there were dozens of tiny, raised black spots. She would later discover they were ant bites.

Her eyes traveled slowly down his body, past the open sores on his forearms to bruises on his emaciated legs. His hands were enormous, "like an elephant's," she recalls. It was difficult to know where to look without cringing. The last time she had seen Tio Rodolfo, he was a barrel-chested, grinning guy who liked to salsa dance. Now his feet had a bluish tint, and there were open sores on the tips of his big toes. These wounds, she would learn, were the work of rats.

Then Yeisleny noticed the 41-year-old's ankles were shackled to the bed.

I know he was in jail before he was brought to the hospital, she thought angrily. But why is he shackled? Where's he going to go? He's dying.

Ramos had been accused of kidnapping and battery when he walked into Miami-Dade's Metro West jail in February 2006. He left a year later — before a trial could be held — in a coma. An ambulance delivered him to Kendall Regional. After seeing his lifeless body — and hearing from a nurse he was 93 percent brain-dead — Yeisleny had called a lawyer and shared her suspicion: The people in the jail "were killing her uncle," she said. Not the inmates, but the guards and medical staff. Ramos, who was diabetic and had other health problems, didn't receive insulin or the proper medical care while behind bars. "He was left to die," Yeisleny says flatly. Indeed Ramos shuffled off this mortal coil April 14; the official cause of death is still undetermined.

Ramos is one of at least seven Miami-Dade inmates who have passed away under suspicious circumstances since January 2006. Some of the others:

• Kippo Pruitt, age 51, was in jail on a drug charge. He died May 21 after slipping into a diabetic coma. Family members say he didn't receive needed insulin.

• Eugene Smith was awaiting trial on attempted murder. The 21-year-old was in a solitary cell and on suicide watch when he overdosed April 1. It is believed he had hoarded medicine provided by prison health care.

• Lazaro Diaz, age 36, complained of chest pains while in jail 18 months ago. He had a heart attack a few days later. His pleas for help might have been ignored by jailers — though they found no "inappropriate behavior" by the staff.

• Willie Daniels, a 57-year-old mentally ill inmate, died of hypothermia in January 2006. Arrested for lunging at an officer, he was found comatose in the psychiatric ward, his temperature a chilly 79 degrees. Jailers called the death accidental.

• Twenty-two-year-old accused gang member Arlin Madrid Reyes complained of stomach pains November 1. He died six days later of salmonella poisoning. Jailers couldn't find the source, but the kitchen was "under health department review," according to an investigation, and 18 others also showed signs of salmonella.

At least 15 other former inmates claim they received shoddy medical care. Many contend they were permanently affected by the poor treatment. All but one were awaiting trial when the subpar care was administered.

Who's responsible? First there's the Corrections Health Service, which is run by the Jackson Public Health Trust and spends $24 million of taxpayers' money each year to care for county inmates. Trust Chairman Ernesto de la Fe, Vice Chairman John Copeland III and board member Javier Souto (who is also a county commissioner) didn't return repeated calls seeking comment.

One Public Health Trust board member — former Miami-Dade Police Capt. Diego Mello — was unaware of the travesty. "I haven't heard anything about this," Mello said when reached by phone. "What you're telling me is new."

Then there's Miami-Dade Corrections Chief Tim Ryan, who took the helm from Charles McRay in late 2006. He is ultimately charged with keeping inmates safe, and alive, while in custody. Following the August 6 suicide of inmate Christopher Walls (who was awaiting trial on charges of killing a bail bondsman) at Turner Guilford Knight Correctional Center, a full review of procedures is under way, the jail chief tells New Times. "[Corrections] investigates every inmate death," Ryan states via e-mail. "We are constantly reviewing policy, procedures, and practices to ensure that we maintain the expected operational levels of the community standards of care."

Says Miami attorney David Kubiliun, who has been in contact with many of the families of the ill and deceased — and plans to sue in federal court soon: "For many years this problem of medical care has been ignored. These people are criminals in the public's eye. No one really cares. But all of these guys have one thing in common: They aren't in a prison. They are accused in the eyes of the law. They are as innocent as you and I."

Miami-Dade houses about 7000 inmates on an average day, which makes it the nation's sixth largest local correctional system. All are serving sentences of less than a year or awaiting trial. About one in four receives some kind of health care. Public Health Trust nurses and doctors do everything from administering cold medicine to performing surgery.

About 89 inmates expired in the cells and medical wards of the county's jails between 2000 and 2005 — most from cancer, heart attacks, or bad living, which makes the system the nation's eighth worst, according to the most recent information from the U.S. Bureau of Justice. (In 2006 18 died, and so far this year, nine more have perished — for a grand total of 117 in seven years.)

Moreover, local jails have had significant problems with medical care in the past few years. In 2003, after 17-year-old Omar Paisley died of a ruptured appendix, a grand jury investigated the Miami-Dade juvenile lockup and Florida lawmakers held hearings. The boy had asked for medical help, but jailers thought he was faking. The result: Three top state juvenile justice administrators were fired.

The same year 13 nurses at Metro West, the county's largest detention center, located on NW 41st Street, complained only three or four nurses worked any given daytime shift — and there was only one nurse at night. "This ... limits their ability to adequately process all requests," the nurses wrote in a letter to administrators. "Patient services are delayed."

And the number of full-time employees in the county's jails continued to decline from 203 in 2003 to 180 in 2006, though the Corrections Health Service budget was steady at around $24 million annually. Some CHS administrators earn more than $120,000 a year. "Obviously the care got worse and worse as the staffing went down," says a nurse who signed the memo.

Yet CHS Medical Director Dr. Kathryn Villano is confident prisoners get the best medical attention possible. "The inmates have much greater access to health care in jail than on the street," she says. "In jail a nurse can refer them to a clinic and they go there within a day or a couple of days."

Corrections Director Tim Ryan told county commissioners in July that because many inmates have health problems — 44 percent of them are diagnosed with some sort of disease — "it is not unusual" that there are deaths. He said it is "safer to be in jail than out in the community."

Ryan tells New Times that although Miami-Dade's corrections agency is the largest in Florida, it ranks number two, behind Jacksonville, in mortality rates. He also says, "The poor health level of inmates has been constantly rising, meaning we should expect a higher health acuity [sic] as well as a higher mortality rate."

Even if Villano and Ryan are correct, inmates and judges often can't convince corrections officers to allow doctor visits to treat the problems, says former Miami-Dade Judge David Young, who left the bench earlier this year. During his six years in court, Young received hundreds of calls from worried family members regarding relatives' suffering in jail. He says he repeatedly ordered the county corrections department to provide medical testing and care, but his instructions were often flubbed or ignored. "You would have thought that we were asking to meet with the president of the United States," Young comments. "I was very frustrated with the lack of quality care received by inmates."

In 2005 Young heard the case of Elizabeth Lingerfeldt, an 18-year-old awaiting trial on armed robbery charges. She asked for a cancer test. The teen's mother had died of cancer, and Lingerfeldt had discovered a lump in her neck — in the same place her mom had found a tumor. The corrections department wouldn't send her to be tested, she said. Young ordered the test, but Assistant County Attorney Randy Duval, on behalf of the corrections department, responded that Young didn't have the authority. Young then released Lingerfeldt. In open court, he told the young woman: "I don't have any faith in the county getting you the medical attention that you need."

"We have a lot of people putting in requests for medical attention," Duval told the Miami Herald. "If every inmate went to the top of the list based on a judge's order rather than their medical needs, it would wreak havoc on the system."

Earl Moffett Jr. had a full head of black hair, flashing brown eyes, and smooth skin when he was arrested January 5 this year. A 30-year-old cook at Burger King, he stood five feet nine inches tall and weighed 196 pounds. A cop had seen him buying a "small, clear packet" of cocaine from another man at NW Seventh Avenue and 77th Street, according to court documents. Moffett was already on probation for waving a knife at his stepsister during an argument, so he probably expected to stay behind bars for a few months when officers delivered him to Turner Guilford Knight.

Because Moffett didn't have much of a prior criminal record, he was almost immediately named a jail trustee, which allowed him to walk the halls and serve food to other inmates. Then in mid-February, Moffett came down with the flu. In March, he says, nurses began injecting him with sulfa antibiotics, though he repeatedly stated he was allergic to that medication. Some officers even accused him of "playing," or faking his illness. "My face started burning, itching, and scratching," he says. "My stomach swelled up. My face swelled up."

In mid-March his mother visited. She barely recognized him. "I just started crying," says Nikki Moffett.

Circuit Court Judge Mark Leban was also shocked by Moffett's appearance. On March 28, the same day the short-order cook was sentenced for violating probation, Leban recommended Moffett receive a medical evaluation. Court records indicate the judge was aware Moffett had "skin problems, chest pains, and breathing problems." He also had contracted a staph infection.

Just days later, Moffett had a seizure and his face was swollen beyond belief, court records show. He went back to court — but corrections officers refused to bring him inside the courtroom because of the way he looked. Attorney Scott Pettus pointed out that his client hadn't yet seen a doctor, so Leban sent his bailiff into the holding cell. After hearing from the bailiff that Moffett was indeed ailing, Leban released the inmate on the spot. The cook immediately hobbled to Jackson Memorial Hospital, where he stayed two weeks.

Now almost four months after his release, Moffett spends his days in front of the television set in his mother's tidy Pembroke Pines condo. He hasn't shaken the staph infection and has another problem on top of that: Stevens-Johnson syndrome, a potentially deadly skin condition that — according to doctors — is likely related to the medicine he was given in jail.

Moffett lost 50-plus pounds and is just now beginning to gain them back. His hands and feet are tough and leathery like the pads on a dog's paws. He itches constantly. His hair has fallen out in clumps. He has spots on his kidneys, trouble hearing in one ear, and looks 50 years old. Moffett has been back to the hospital seven times since his two-week stay, and has racked up $75,000 in medical bills, none of which he can pay. His mom has also contracted the staph infection.

Moffett says he plans to sue. "The way they treated me was like a dog," he says while sticking his hand down the side of his pants to scratch his upper thigh.

Kippo Pruitt was 55 when he landed at the Metro West Detention Center March 31, charged with selling marijuana near a school.

A Vietnam veteran with an honorable discharge, Pruitt had racked up several charges over the years, from the very minor (possession of a shopping cart) to the more serious (dealing cocaine). Along with his demons, Pruitt struggled with diabetes. He needed insulin to survive. When he walked into the jail, his four daughters hoped this would be his last time behind bars.

Over the next month, Pruitt's health inexplicably declined. One inmate reported seeing him arguing with a nurse over a scheduled insulin dose. He also complained of chest pains. During visiting hours, a family friend saw Pruitt and reported back that he "looked sick," according to his daughter, 19-year-old Ke'Tara.

On May 11, Pruitt collapsed in his cell. He was taken to Kendall Regional Medical Center and shackled to a bed. He was comatose by May 17, when Ke'Tara and her three sisters discovered their father was sick. "Why didn't anyone notify us to say he was in the hospital?" Ke'Tara wonders. "They had my number, because I had called the jail clinic to ask about his health."

Pruitt died May 21. The official reason: "cerebral intraparenchymal hemorrhage." In other words, a stroke. The medical examiner deemed the cause of death natural. Pruitt's children suspect he wasn't given the proper dose of insulin.

"My father was absolutely okay until he got to the jail," says Ke'Tara.

Rodolfo Ramos's case is frighteningly like that of Kippo Pruitt. One day in January — his niece, Yeisleny, doesn't remember exactly when — she got a call from her uncle. He spoke in a quick, excited voice. "Los elefantes quieren comerme," he said. The elephants want to eat me.

Another inmate got on the phone. Ramos's friend "Camagüey" sounded sad and worried. "Your uncle is hallucinating," he told her. "You should call the clinic."

Ramos was born in Camagüey, Cuba — like his jailhouse buddy — April 16, 1965. In the decades that followed, his father and sister moved to Miami. Ramos got a visa and joined the family in 1995. They all lived in a small house in Hialeah, a few blocks north of the Westland Mall.

But for Ramos, life in many ways was more difficult in Miami than it had been in Cuba. He worked for a spell as a massage therapist and then as a delivery driver. In 1996 he was picked up for drunk driving, but those charges were later dropped. The following year he was convicted of larceny and served a few months in jail.

For a few years it seemed Ramos had gotten his act together. He would take his young niece Yeisleny to the movies and go to happy hour with friends. He began working at a Hialeah warehouse, again as a delivery truck driver. Although a doctor had diagnosed him with diabetes, Ramos had little problem controlling his blood sugar or weight, probably because of the exercise he got at work and his love of salsa dancing. At six feet one inch, Ramos weighed a respectable 190 pounds.

Then, in early 2006, Ramos got mixed up in something heavier. A man named Wilfredo Velunza said Ramos and two other men had kidnapped him, beaten him with a hammer, and stolen $12,000 in cash. The victim and the three alleged kidnappers had varying accounts of the February 2 incident. One said it was a drug deal gone bad, another claimed Ramos and his two co-conspirators were part of a "drug rip-off ring." And it got weirder. During a beating, the alleged kidnappers allowed Velunza to use the phone — and instead of contacting family or police, the victim phoned his lawyer.

Regardless, these weren't the misdemeanor charges of years past. If convicted, Ramos faced life in prison. He was taken into custody February 20, and after three months at TGK was transferred to Metro West. A judge denied Ramos bond owing to the severity of the charges, and he settled into life behind bars. Every Saturday his elderly father visited; at least every other day he'd call his niece.

Soon the family became concerned. Ramos began to use a cane. He also complained he needed special shoes and socks for diabetics but the jail staff had refused to provide them. And he said the medical staff didn't always provide insulin when it was needed. He was also diagnosed by jail doctors with sarcoidosis, a nonlethal chronic disease that produces tiny lumps of cells in various organs.

"Can you please call over here and tell them that I need my medicine?" he would ask Yeisleny. She'd phone, and he would usually receive the insulin. He also took some other pills, but she wasn't sure of the type.

Those troubling calls continued through January and February this year. Camagüey called one day to say Ramos's adult diaper was full.

Then Ramos was given a wheelchair, Yeisleny discovered, because he couldn't walk or move his extremities. He hallucinated and frequently talked of flying pigs.

A report written by a jail guard summed up the situation: "Anywhere between 2-5 times a day, select inmates have to wash and dry [Ramos's] linen, his uniform, and give him a shower. Inmate Ramos takes approximately 20 pills on the 7 to 3 shift alone, which makes him very weak. To make matters worse, inmate Ramos is becoming very defiant and argumentative. Other inmates in the unit make fun of the inmates that take care of him."

The officer, whose name is not on the report, continued, "I have made several attempts to medical staff to try and resolve this situation, but to no avail. Inmate Ramos ... needs to be in a medical housing unit. This situation needs to be addressed immediately in order to prevent a tragic unforeseen incident."

But Ramos wasn't transferred to a hospital. In early March he was placed in a cell in the solitary confinement wing. Camagüey called Yeisleny. "Your uncle is really bad," he told her. "They just moved him to a one-man cell. He's going to die in there."

On Saturday, March 25, Ramos's father traveled to the jail but was told his son "didn't feel like visiting." That night at 11:38, according to jail records, Ramos was found in his cell, unresponsive. He was covered in his own feces and had open sores all over his body. Paramedics showed up nearly 40 minutes later. No one from the jail staff called the family.

The next day Ramos missed a scheduled court appearance. It took several calls for Yeisleny to discover he had been taken to the hospital in Kendall. He was in a coma. Exacerbating the situation: The family had to get an emergency court order to visit Ramos in the hospital. "We never thought this kind of thing would happen in the United States," Yeisleny says, her eyes tearing up.

Ramos died April 14, 2007. Two weeks later Yeisleny and her lawyers held a press conference to show the world the horrific photos of her uncle on his deathbed. The tale of the ant-bitten, diabetic inmate was picked up by the Associated Press; the story also ran in the Washington Post.

The county's corrections department issued a tepid response: "'While incarcerated, Mr. Ramos was regularly seen by doctors and medical staff, and hospitalized as needed. While Mr. Ramos's medical history is quite extensive and complex, there is no indication of a lack of medical care or attention in his case. However, as with any death at our corrections facilities, Miami-Dade County is investigating this matter.''

The story hit one 33-year-old Hialeah man, Chris Jimenez, hard. A diabetic like Ramos, he had been locked up for two weeks in 2005 at Metro West on a violation of probation charge. The guards, he recalls, made it difficult for him to get insulin and food. Nurses sometimes gave him an incorrect dose or none at all. Not long after his release, the former army officer's blood sugar level spun out of control. Then he contacted county leaders, including Mayor Carlos Alvarez, to complain about inadequate medical care at the jail.

Then came Ramos. "This death could have been avoided," Jimenez says. "I was given promises that things were going to be fixed, procedures changed. Nothing was taken care of. The people at the jail are not doing their job."

Shortly after Ramos's death, several nurses were talking in Ward D, the medical wing at Metro West. They discussed the ant bites, the feces, the rats. They recalled how they had given him insulin and how his condition had deteriorated over several months. They questioned whether they could have done more.

"We sat there in horror as we talked," says one nurse, who asked not to be identified for fear she would lose her job. The nurse, who has worked around inmates for several years and has the no-nonsense demeanor of a schoolmarm, had tears in her eyes as she thought about Ramos in solitary. "The cell was almost as big as his wheelchair," she says. "A safety cell. He wasn't a high risk of escape."

The situation bothered her so much she decided to speak up — as much as she dared. On June 22 she wrote an anonymous letter to Corrections Director Ryan. It accused a high-ranking nurse of incompetence. "As a direct result, inmates ... are placed in danger because proper techniques and procedures are not encouraged and followed. The recent tragedy with Inmate Rodolfo Ramos illustrates the above statement because proper technique and procedures were not followed."

Though the letter contained nine fax numbers at the jail and Jackson hospital, New Times could not confirm it was sent or received.

There is no indication in the high-ranking nurse's personnel file of complaints or problems. She is a 20-plus-year employee of Jackson Health System who has received excellent reviews.

Asked about the letter and allegations, Jackson spokeswoman Lorraine Nelson e-mailed a three-line response: "Jackson Health System takes these allegations very seriously. We will conduct an internal investigation. At this time, we have no further comments on this issue."

Moreover, the Health Trust insists it gives inmates proper care. Despite the 117 deaths, there has seemingly been little fallout. Arthur Brown, director of nursing for CHS, resigned from his job July 3, said Robert Alonso, Jackson's vice president of public affairs and marketing.

The documents in Brown's personnel file indicate the 25-year employee had done well at his job. There is, however, one sign he wasn't completely focused on the $121,000-a-year job: He submitted two requests to work an outside job, once in 1996 and again in 2005 — the year 16 people died in county jails.

Brown couldn't be reached for comment. Asked if the resignation had anything to do with allegations of poor treatment, Alonso responds only that it was because of "personal reasons."

Says the anonymous nurse: "It's just a job for them. They're getting a salary — they don't care."

Sometime soon, Miami attorney Kubiliun and his partner Lynn Overmann, both former public defenders, plan to file a lawsuit in federal court on behalf of five dead inmates — including Ramos and Kippo — and more than a dozen others who are still alive. In June they sent the Health Trust and the county corrections department notice of the suit.

The plaintiff list could grow. Word has gotten around the jail of the coming legal battle, so the pair receives at least two calls a day from inmates or their families about medical mistreatment behind bars. And letters — penned by inmates who claim they were denied insulin and other medicine in Miami-Dade's lockup — have arrived from as far away as the state prison in Raiford.

Kubiliun might also champion the case of those locked up in the jail's solitary confinement cells, where Ramos was kept. Twenty-four-year-old inmate Waltaire Choute hanged himself in one of those cells May 27. And Christopher Walls, who was 32, did the same August 5. Kubiliun wonders whether jailers checked on the men every half-hour — as required by jail procedure.

Phone records show Choute spoke with family members at 5:02 p.m. According to jail records, he hanged himself by 5:22. "I don't think he had enough time to do that," says Kubiliun. "Something doesn't add up."

And Walls, who was awaiting trial on charges that he killed a bail bondsman, allegedly committed suicide two weeks after corrections officers left him inside a locked van for two hours in the sweltering daytime heat. Walls's family wonders whether the guards might have had a vendetta against the prisoner. "He was calling us every day, stressed out," says Walls's sister, Debora Stovall, age 39. "He was afraid for his life. For a while we thought he was making stuff up, but after the van incident, we got afraid for him too."

Kubiliun and Overmann will try to prove county jailers are not devoting enough time, effort, and money to the inmates' care, medical and otherwise. The two attorneys know it will be a tough fight. Their clients won't arouse much sympathy in a jury. Some are career criminals with lengthy felony convictions; others are low-grade bad guys who just can't stay out of trouble or away from drugs.

It's unclear where all of this will lead. In late April, shortly after Ramos's death, Kubiliun contacted the U.S. Department of Justice to describe the problems in Miami's jails. He sent documents of several cases, including photos of Ramos on his deathbed.

Kubiliun and Overmann are determined to continue the fight, even if it takes years. After all, even the alleged terrorists locked down at Guantánamo Bay, Cuba, receive decent health care.

County leaders deny there is a problem. "To say that inmates are not getting the best, I totally disagree with that," says county Commissioner Rebeca Sosa. The only problem, she says, is the amount of money inmate medical care is costing taxpayers.

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